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NC Medicaid Telehealth Billing Code Summary 1 of 22 June 25, 2020 NC Medicaid Telehealth Billing Code Summary UPDATE (June 25, 2020) Updated Telehealth Guidance: Codes that require 2 modifiers (i.e., GT and CR) must be billed with both modifiers or the claim detail will deny. o Updated Table 2. Telepsychiatry and Telebehavioral Health Services o Updated Table 13. Perinatal Care Updated Table 21. Skilled Nursing Facilities includes new evaluation and management codes See the Appendix for a complete list of updates. ____________________________________________________________________________________________________________________________ NC Medicaid is temporarily modifying its Telemedicine and Telepsychiatry Clinical Coverage Policy to better enable the delivery of remote care to Medicaid and NC Health Choice members. These temporary changes are effective retroactive to March 10, 2020, and will end the earlier of the cancellation of the North Carolina state of emergency declaration or when this policy is rescinded. The tables below outline revised billing guidance for telehealth codes. Providers should reference the Medicaid Special COVID-19 Bulletins more specific coding and billing guidance.

Transcript of NC Medicaid Telehealth Billing Code Summary...NC Medicaid Telehealth Billing Code Summary 3 of 22...

Page 1: NC Medicaid Telehealth Billing Code Summary...NC Medicaid Telehealth Billing Code Summary 3 of 22 May 21, 2020 TABLE 1. PRESCRIBERS(MEDICAL AND BEHAVIORAL HEALTH) Service Applicable

NC Medicaid Telehealth Billing Code Summary 1 of 22 June 25, 2020

NC Medicaid Telehealth Billing Code Summary

UPDATE (June 25, 2020) • Updated Telehealth Guidance: Codes that require 2 modifiers (i.e., GT and CR) must be billed with both modifiers or the claim detail will deny.

o Updated Table 2. Telepsychiatry and Telebehavioral Health Services

o Updated Table 13. Perinatal Care

• Updated Table 21. Skilled Nursing Facilities includes new evaluation and management codes

See the Appendix for a complete list of updates.

____________________________________________________________________________________________________________________________

NC Medicaid is temporarily modifying its Telemedicine and Telepsychiatry Clinical Coverage Policy to better enable the delivery of remote care to Medicaid and NC Health Choice members. These temporary changes are effective retroactive to March 10, 2020, and will end the earlier of the cancellation of the North Carolina state of emergency declaration or when this policy is rescinded. The tables below outline revised billing guidance for telehealth codes. Providers should reference the Medicaid Special COVID-19 Bulletins more specific coding and billing guidance.

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NC Medicaid Telehealth Billing Code Summary 2 of 22 June 25, 2020

Contents Table 1. Prescribers (Medical and Behavioral Health) .................................................................................................................................. 3

Table 2. Telepsychiatry and Telebehavioral Health Services ........................................................................................................................ 4

Table 3. Teletherapy ..................................................................................................................................................................................... 6

Table 4. Teledentistry ................................................................................................................................................................................... 6

Table 5. Local Education Agencies Teletherapy............................................................................................................................................ 7

Table 6. Children’s Developmental Services Agencies (CDSAs) – NC Infant Toddler Program (NC ITP) Services......................................... 7

Table 7. Diabetes Self-Management Education (DSME) .............................................................................................................................. 9

Table 8. Dietary Evaluation and Counseling ............................................................................................................................................... 10

Table 9. Medical Lactation .......................................................................................................................................................................... 10

Table 10. Research-based Behavioral Health (RB-BHT) Treatment for Autism Spectrum Disorder (ASD) ................................................. 11

Table 11. Self-measured Blood Pressure Monitoring (SMBPM) Services ................................................................................................... 11

Table 12. Optometry ................................................................................................................................................................................... 12

Table 13. Perinatal Care .............................................................................................................................................................................. 12

Table 14. Remote Physiologic Monitoring .................................................................................................................................................. 13

Table 15. Well Child Visits ........................................................................................................................................................................... 13

Table 16. Postpartum Depression Screening .............................................................................................................................................. 14

Table 17. Health and Behavior Intervention Visits Provided by Local Health Departments ...................................................................... 14

Table 18. Outpatient Respiratory Therapy ................................................................................................................................................. 14

Table 19. Hybrid Telemedicine with Supporting Home Visit ...................................................................................................................... 15

Table 20. End-Stage Renal Disease (ESRD) ................................................................................................................................................. 16

Table 21. Skilled Nursing Facilities .............................................................................................................................................................. 16

Table 22. Enhanced Behavioral Health Services ......................................................................................................................................... 16

Table 23. Maternal Support Services Provided by Local Health Departments........................................................................................... 19

Table 24. Family Planning Services for MAFDN Beneficiaries .................................................................................................................... 20

Table 25. Smoking and Tobacco Cessation Counseling .............................................................................................................................20

Appendix: List of Updates to the NC Medicaid Telehealth Billing Code Summary .................................................................................... 21

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NC Medicaid Telehealth Billing Code Summary 3 of 22 June 25, 2020

TABLE 1. PRESCRIBERS (MEDICAL AND BEHAVIORAL HEALTH) Service Applicable Providers RATE CODE OR PROCEDURE Modifiers & POS Source Bulletin

TELEMEDICINE Office or Other Outpatient Service and Office and Inpatient Consultation

• Advanced practice midwives • Clinical pharmacist practitioners • FQHCs, FQHC Look-Alikes & RHCs* • Nurse practitioners • Physicians • Physician assistants • Psychiatric nurse practitioners

99201, 99202, 99203, 99204, 99205, 99211, 99212 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255

• Reported with usual place of service (POS)

• Modifiers GT & CR • For additional information

about providing and billing these services: NC Medicaid clinical coverage policy 1H, telemedicine/telepsychiatry

Special Bulletin COVID-19 #34: Telehealth Clinical Policy Modifications – Definitions, Eligible Providers, Services and Codes

*FQHCs, FQHC Look-Alikes and RHCs only: T1015

• POS 50 (FQHC) or 72 (RHC) • Modifiers GT & CR

VIRTUAL PATIENT COMMUNICATIONS Telephone Evaluation and Management

• Advance practice midwives • FQHCs, FQHC Look-Alikes & RHCs* • Nurse practitioners • Physicians • Physician assistants

99441, 99442, 99443, G2012 • Reported with usual place of service (POS)

• Modifier CR

Special Bulletin COVID-19 #34: Telehealth Clinical Policy Modifications – Definitions, Eligible Providers, Services and Codes

*FQHCs, FQHC Look-Alikes and RHCs only: G0071

• POS 50 (FQHC), 72 (RHC) • Modifier CR

Online digital Evaluation and Management

• Advance practice midwives • FQHCs, FQHC Look-Alikes & RHCs • Nurse practitioners • Physicians • Physician assistants

99421, 99422, 99423 • Reported with usual place of service (POS)

• Modifier CR

Interprofessional Assessment and Management

Consulting physicians bill for services requested by a physician, physician assistant, nurse practitioner or certified nurse midwife

99446, 99447, 99448, 99449 • Reported with usual place of service (POS)

• Modifier CR

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NC Medicaid Telehealth Billing Code Summary 4 of 22 June 25, 2020

TABLE 2. TELEPSYCHIATRY AND TELEBEHAVIORAL HEALTH SERVICES SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

TELEPSYCHIATRY Psychiatric Diagnostic Evaluation and Psychotherapy (see to Clinical Coverage Policy 8C. For FQHCs, FQHC Look-Alikes and RHCs, see Clinical Coverage Policy 1D-4)

• FQHCs, FQHC Look-Alikes and RHCs*

• Licensed clinical addiction specialists

• Licensed clinical addiction specialist associates

• Licensed marriage and family therapists

• Licensed marriage and family therapist associates

• Licensed clinical mental health counselors (formerly licensed professional counselors)

• Licensed clinical mental health counselor associates

• Licensed psychologists • Licensed psychological associates • Licensed clinical social workers • Licensed clinical social worker

associate • Physicians • Physicians assistants Psychiatric nurse practitioners (as allowed by Clinical Coverage Policy 8C, Section 6.1.m.)

90785α, 90791Þ, 90792±, 90832Þ, 90833±Þ, 90834Þ, 90836±Þ, 90837Þ, 90838±Þ, 90839Þ, 90840Þ, 90846Þ, 90847Þ, 90849 Þ, 90853Þ ±Only billable by licensed psychiatric prescribing providers α May be provided telephonically when being used for interpreter services. Þ If two-way audio-visual options are not accessible to the beneficiary, services may be offered via telephonic modality.

• Reported with usual place of service (POS)

• Services that are not COVID-19 related should continue to be billed in accordance with NC Medicaid clinical coverage policy 1H, telemedicine/telepsychiatry

• When delivered via

telemedicine (real time, two-way audio/visual): Modifiers GT & CR

• When delivered telephonically: CR only

Special Bulletin COVID-19 #34: Telehealth Clinical Policy Modifications – Definitions, Eligible Providers, Services and Codes Special Bulletin COVID-19 #59: Telehealth Clinical Policy Modifications - Outpatient Behavioral Health Services

*FQHCs, FQHC Look-Alikes and RHCs only: T1015-HI

• POS 50 (FQHC) or 72 (RHC) • Modifiers GT & CR

Screening and Testing Codes (see to Clinical Coverage Policy 8C)

• Psychiatrists/Physicians • Licensed psychologists • Licensed psychological Associates • Psychiatric nurse practitionersα • Physician Assistantsα

96110α, 96112, 96113, 96116, 96121, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96146 αPsychiatric Nurse Practitioners and Physician Assistants can only bill 96110

• Reported with usual place of service (POS)

• Modifiers GT & CR

Inpatient Codes • Certified psychiatric-mental health nurse practitioners

• Psychiatrists

99231, 99232, 99233, 99238, 99239

• Reported with usual place of service (POS)

• Modifiers GT & CR

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NC Medicaid Telehealth Billing Code Summary 5 of 22 June 25, 2020

TABLE 2. TELEPSYCHIATRY AND TELEBEHAVIORAL HEALTH SERVICES SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Enhanced and Other Behavioral Health Services

• Assertive Community Treatment (ACT) providers

• Community Support Team (CST) providers

• Intensive in-home Services providers

• Mobile crisis management providers

• Multisystemic therapy providers • Peer Supports Services (PSS)

providers

H2022, H2033, H2011, H0040, H2015HT, H0038

• Reported with usual place of service (POS)

• Modifiers GT & CR

8A, 8A-1, 8A-6, and 8G

Special Bulletin COVID-19 #35: Telehealth Clinical Policy Modifications – Enhanced Behavioral Services

VIRTUAL PATIENT COMMUNICATION Telephone Assessment and Management

• Licensed clinical addiction specialists

• Licensed clinical addiction specialist associates

• Licensed clinical social workers • Licensed clinical social worker

associates • Licensed marriage and family

therapists • Licensed marriage and family

therapist associates • Licensed clinical mental health

counselors (formerly licensed professional counselors)

• Licensed clinical mental health counselor associates

• Licensed psychologists • Licensed psychological associates • FQHC, FQHC lookalikes and RHCs*

98966, 98967, 98968

*Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) may bill for services provided by licensed clinical addiction specialists, licensed clinical mental health counselors, licensed psychologists, licensed psychological associates, licensed clinical social workers and licensed marriage and family therapists

• Reported with usual place of service (POS)

• Modifier CR

Special Bulletin COVID-19 #34: Telehealth Clinical Policy Modifications – Definitions, Eligible Providers, Services and Codes

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NC Medicaid Telehealth Billing Code Summary 6 of 22 June 25, 2020

TABLE 3. TELETHERAPY SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Outpatient Specialized Therapies (Clinical Coverage Policies 10A and 10B)

Audiologists 92630, 92633 • Reported with usual place of service (POS)

• Modifiers GT & CR

Special Bulletin COVID-19 #36: Telehealth Clinical Policy Modifications – Outpatient Specialized Therapies and Dental Services

Physical therapists 97161, 97162, 97163, 97164, 97750, 97110, 97112, 97116, 97530, 97533, 97535, 97542, 97763, 95992

• Reported with usual place of service (POS)

• Modifiers GT & CR

Occupational therapists 92065, 92526 (oral function and feeding only), 97110, 97112, 97116, 97165, 97166, 97167, 97168, 97530, 97533, 97535, 97542, 97763, 97750

• Reported with usual place of service (POS)

• Modifiers GT & CR

Speech language therapists 92521, 92522, 92523, 92524, 92607, 92608, 96125, 92507, 92526 (oral function and feeding only), 92609, 92630, 92633

• Reported with usual place of service (POS)

• Modifiers GT & CR

*Teletherapy requires the use of real-time, two-way audio video capability*

TABLE 4. TELEDENTISTRY SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Teledentistry Dentists D0140, D0170, D0999, D9995, D9996

• POS 02 • Dental codes will not use

CR or GT modifiers • D9995 and D9996 require

video and/or photos and must be reported with oral evaluation codes D0140 or D0170

• D0999 must be reported for patient telephonic encounters with real time/live audio interactions only and are not allowed to be reported with any other service

Special Bulletin COVID-19 #36: Telehealth Clinical Policy Modifications – Outpatient Specialized Therapies and Dental Services

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NC Medicaid Telehealth Billing Code Summary 7 of 22 June 25, 2020

TABLE 5. LOCAL EDUCATION AGENCIES TELETHERAPY SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Outpatient Specialized Therapies, Local Education Agencies (LEAs) (Clinical Coverage Policy 10C)

Audiologists 92630, 92633 • Reported with usual place of service (POS)

• Modifiers GT & CR

Special Bulletin COVID-19 #36: Telehealth Clinical Policy Modifications – Outpatient Specialized Therapies and Dental Services

Physical therapists 97161, 97162, 97163, 97164, 97750, 97110, 97112, 97116, 97530, 97533, 97535, 97542, 97763, 95992

• Reported with usual place of service (POS)

• Modifiers GT & CR

Occupational therapists 97165, 97166, 97167, 97168, 97750, 92065, 92526 (oral function and feeding only), 97110, 97112, 97116, 97530, 97533, 97535, 97542, 97763

• Reported with usual place of service (POS)

• Modifiers GT & CR

Speech language therapists 92521, 92522, 92523, 92524, 92526 (oral function and feeding only), 92607, 92608, 96125, 92507, 92609, 92630, 92633

• Reported with usual place of service (POS)

• Modifiers GT & CR

Appropriate psychology and/or counseling professional per policy 10C

90832, 90834, 90837, 90847, 96110, 96112, 96113, 96130, 96131

• Reported with usual place of service (POS)

• Modifiers GT & CR

Special Bulletin COVID-19 #34: Telehealth Clinical Policy Modifications – Definitions, Eligible Providers, Services and Codes

TABLE 6. CHILDREN’S DEVELOPMENTAL SERVICES AGENCIES (CDSAS) – NC INFANT TODDLER PROGRAM (NC ITP) SERVICES SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Telemedicine, Teletherapy, Telepsychiatry

Audiologists 92630, 92633, T1023 • Reported with usual place of service (POS)

• Modifiers GT & CR

Special Bulletin COVID-19 #34: Telehealth Clinical Policy Modifications – Definitions, Eligible Providers, Services and Codes Educational diagnosticians 96110, 96112, 96113, T1023 • Reported with usual place

of service (POS) • Modifiers GT & CR

Infant/Family/Toddler specialists 96110, 96112, 96113, H0036, H0036-HI, H0036-HM, H0036-HQ, H0036-TL, H0036-UI, T1017, T1023

• Reported with usual place of service (POS)

• Modifiers GT & CR

Licensed clinical social workers 90832, 90834, 90837, 90846, 90847, 96110, 96112, 96113, H0031, T1023

• Reported with usual place of service (POS)

• Modifiers GT & CR

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NC Medicaid Telehealth Billing Code Summary 8 of 22 June 25, 2020

TABLE 6. CHILDREN’S DEVELOPMENTAL SERVICES AGENCIES (CDSAS) – NC INFANT TODDLER PROGRAM (NC ITP) SERVICES SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

• Licensed clinical mental health counselors (formerly licensed professional counselors)

• Licensed marriage and family therapists

• Licensed psychological associates

90832, 90834, 90837, 90846, 90847, H0031

• Reported with usual place of service (POS)

• Modifiers GT & CR

Nurse practitioners (medical and psychiatric)

90832, 90834, 90837, 96112, 96113, 99211, 99212, 99213, 9214, 99215, T1023

• Reported with usual place of service (POS)

• Modifiers GT & CR Nutritionists 96112, 96113, 97802, 97803,

T1023 • Reported with usual place

of service (POS) • Modifiers GT & CR

Occupational therapists 92526 (oral function and feeding only), 96110, 96112, 96113, 97110, 97112, 97116, 97165, 97166, 97167, 97168, 97533, 97535, 97542, 97750, 97763, T1023

• Reported with usual place of service (POS)

• Modifiers GT & CR

Physicians 90832, 90834, 90837, 96110, 96112, 96113, 96116, 96121, 96132, 96133, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, T1023

• Reported with usual place of service (POS)

• Modifiers GT & CR

Physician assistants 96112, 96113, 99211, 99212, 99213, 99214, 99215

• Reported with usual place of service (POS)

• Modifiers GT & CR Physical therapists 92526 (oral function and

feeding only), 96110, 96112, 96113, 97110, 97112, 97116, 97162, 97163, 97164, 97533, 97535, 97542, 97750, 97763, T1023

• Reported with usual place of service (POS)

• Modifiers GT & CR

Psychologists 90832, 90834, 90837, 90846, 90847, 96110, 96112, 96113, 96116, 96121, 96130, 96131, 96132, 96133, H0031, T1023

• Reported with usual place of service (POS)

• Modifiers GT & CR

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NC Medicaid Telehealth Billing Code Summary 9 of 22 June 25, 2020

TABLE 6. CHILDREN’S DEVELOPMENTAL SERVICES AGENCIES (CDSAS) – NC INFANT TODDLER PROGRAM (NC ITP) SERVICES SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Registered dieticians 96110, 96112, 96113, 97802, 97803

• Reported with usual place of service (POS)

• Modifiers GT & CR Registered nurses who are Qualified Professionals

96112, 96113, T1023 • Reported with usual place of service (POS)

• Modifiers GT & CR Speech language therapists 92507, 92521, 92522, 92523,

92524, 92526 (oral function and feeding only), 92630, 92633, 96110, 96112, 96113, T1023

• Reported with usual place of service (POS)

• Modifiers GT & CR

TABLE 7. DIABETES SELF-MANAGEMENT EDUCATION (DSME) SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Diabetes Self-Management Education

Non-physician practitioners: • Behaviorists who are Ed.D.

prepared • Certified diabetes educators

(CDE) • Registered dieticians who are

employed by physicians or entities

• Registered nurses Physician practitioners/sites: • Certified nurse midwives • Clinical pharmacist practitioners

(CPP) • Federally qualified health

centers/rural health clinics • Hospital outpatient departments • Local health departments • Nurse practitioners • Physicians • Physician assistants

G0108 • Reported with usual place of service (POS)

• Modifiers GT & CR

1A-24.pdf

1A-24, Diabetes Outpatient Self-Management Education

Special Bulletin COVID-19 #34: Telehealth Clinical Policy Modifications – Definitions, Eligible Providers, Services and Codes

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NC Medicaid Telehealth Billing Code Summary 10 of 22 June 25, 2020

TABLE 8. DIETARY EVALUATION AND COUNSELING SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Dietary Evaluation and Counseling

• Licensed dieticians or nutritionists (currently licensed by the N.C. Board of Dietetics Nutrition)

• Registered dieticians

97802, 97803 • Reported with usual place of service (POS)

• Modifiers GT & CR

1-I-.pdf

1-I, Dietary Evaluation and Counseling and Medical Lactation Services

Special Bulletin COVID-19 #34: Telehealth Clinical Policy Modifications – Definitions, Eligible Providers, Services and Codes

TABLE 9. MEDICAL LACTATION SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Medical Lactation Support

• Certified nurse midwives • International board-certified

lactation consultants (IBCLC) • Nurse practitioners • Physicians • Physician assistants

96156, 96158, 96159 • Reported with usual place of service (POS)

• Modifiers GT & CR

1-I-.pdf

1-I, Dietary Evaluation and Counseling and Medical Lactation Services

Special Bulletin COVID-19 #34: Telehealth Clinical Policy Modifications – Definitions, Eligible Providers, Services and Codes

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NC Medicaid Telehealth Billing Code Summary 11 of 22 June 25, 2020

TABLE 10. RESEARCH-BASED BEHAVIORAL HEALTH (RB-BHT) TREATMENT FOR AUTISM SPECTRUM DISORDER (ASD) SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

RB-BHT for ASD Licensed Qualified Autism Service Providers (LQASP): • Developmental or behavioral

pediatricians • Licensed clinical social workers • Licensed clinical mental health

counselors (formerly licensed professional counselors)

• Licensed marriage and family therapists

• Licensed psychologists • Licensed psychological assistants • Occupational therapists • Physicians • Speech and language pathologists

Providers of Research Based - Behavioral Health Treatment when those services are delivered by: • Certified – qualified professional

or • Technician under the supervision

of a LQASP

97151, 97152, 97153, 97154, 97155*, 97156Þ, 97157Þ *In administering 97155, the physician or other qualified health care professional resolves one or more problems with the protocol and may simultaneously direct a technician in administering the modified protocol while the patient is present. Physician or other qualified health care professional direction to the technician without the patient present is not reported separately. Þ If two-way audio-visual options are not accessible to the beneficiary, services may be offered via telephonic modality.

• Reported with usual place of service (POS)

• Modifiers GT & CR ÞModifier CR only

Special Bulletin COVID-19 #34: Telehealth Clinical Policy Modifications – Definitions, Eligible Providers, Services and Codes Special Bulletin COVID-19 #59: Telehealth Clinical Policy Modifications - Outpatient Behavioral Health Services

TABLE 11. SELF-MEASURED BLOOD PRESSURE MONITORING (SMBPM) SERVICES SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Self-Measured Blood Pressure Monitoring

• Physicians • Nurse practitioners • Physician assistants • Certified nurse midwives • FQHCs, FQHC Lookalikes and RHCs

99473, 99474 • Reported with usual place of service (POS)

• Modifier CR (all claims)

SPECIAL BULLETIN COVID-19 #43: Telehealth Clinical Policy Modifications – Self-Measured Blood Pressure Monitoring

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NC Medicaid Telehealth Billing Code Summary 12 of 22 June 25, 2020

TABLE 12. OPTOMETRY SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Office or Other Outpatient Service

Optometrists 99211, 99212, 99213, 99214, 99215

• Reported with usual place of service (POS)

• Modifiers GT & CR

SPECIAL BULLETIN COVID-19 #41: Telehealth Clinical Policy Modifications – Optometry Services

Virtual patient communication

99421, 99422, 99423, 99441, 99442, 99443, G2012

• Reported with usual place of service (POS)

• Modifier CR Interprofessional Consultation

99446, 99447, 99448, 99449 • Reported with usual place of service (POS)

• Modifier CR

TABLE 13. PERINATAL CARE SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Perinatal Care • Physicians • Nurse practitioners • Physician assistants • Certified nurse midwives • FQHCs, FQHC Lookalikes and RHCs*

59400, 59510, 59410, 59515, 59425, 59426, 59430

• Reported with usual place of service (POS)

• If at least one visit was conducted via telemedicine: Modifiers GT and CR

SPECIAL BULLETIN COVID-19 #49: Telehealth Clinical Policy Modifications – Interim Perinatal Care Guidance

HCPCS codes: S0280, S0281 • Modifiers GT & CR are not required

*FQHCs, FQHC Look-Alikes and RHCs only: T1015 for perinatal services rendered by core service providers

• Reported with usual place of service (POS)

• Modifiers GT & CR

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NC Medicaid Telehealth Billing Code Summary 13 of 22 June 25, 2020

TABLE 14. REMOTE PHYSIOLOGIC MONITORING SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Remote Patient Monitoring

• Physicians • Nurse practitioners • Physician assistants • Certified nurse midwives • FQHCs, FQHC Lookalikes and RHCs

99453, 99454 • Reported with usual place of service (POS)

• Modifier CR

SPECIAL BULLETIN COVID-19 #48: Telehealth Clinical Policy Modifications – Remote Physiologic Monitoring Services

Remote Physiologic Monitoring (RPM) Treatment Management Services

99457, 99458

TABLE 15. WELL CHILD VISITS SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Well Child Visits for children under 24 months

• Physicians • Nurse practitioners • Physician assistants • FQHCs, FQHC Lookalikes and RHCs

90460±, 96110, 96127, 96160, 96161, 99211°, 99212°, 99213°, 99214°, 99215°, 99381, 99382, 99391, 99392

All codes should be reported with usual place of service (POS)

Telemedicine For Medicaid: • Modifiers EP, GT & CR

For NC Health Choice: • Modifiers TJ, GT & CR

99211-99215 follow-up in-person visits • Modifier CR

±90460 For Medicaid • Modifiers EP & CR

For NC Health Choice • Modifiers TJ & CR

SPECIAL BULLETIN COVID-19 #66: Telehealth and Virtual Patient Communications Clinical Policy Modifications - Well Child Visits

Well Child Visits for patients 24 months and older

90460±,96110, 96127, 96160, 99211°, 99212°, 99213°, 99214°, 99215°, 99382, 99383, 99384, 99385, 99392, 99393, 99394, 99395

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NC Medicaid Telehealth Billing Code Summary 14 of 22 June 25, 2020

TABLE 16. POSTPARTUM DEPRESSION SCREENING SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Postpartum Depression Screening

• Physicians • Nurse practitioners • Physician assistants • Certified nurse midwives • FQHCs, FQHC Lookalikes and RHCs*

96127, 96161±

*Postpartum screenings delivered as part of an obstetrics care visit are covered under core obstetrics billing (T1015). Postpartum depression screenings delivered as part of Well Child Visits are reimbursed on a fee-for-service basis.

• Reported with usual place of service (POS)

• Delivered via telemedicine: o Modifiers GT & CR

• Delivered via telephone or online patient communication: o Modifier CR

±For 96161, append EP modifier.

SPECIAL BULLETIN COVID-19 #65: Telehealth and Virtual Patient Communications Clinical Policy Modifications - Postpartum Depression Screening

TABLE 17. HEALTH AND BEHAVIOR INTERVENTION VISITS PROVIDED BY LOCAL HEALTH DEPARTMENTS SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Health and Behavior Intervention

Licensed Clinical Social Workers rendering care within Local Health Departments

96158, 96159 • Reported with usual place of service (POS)

• Modifiers GT & CR

SPECIAL BULLETIN COVID-19 #64: Telehealth and Virtual Patient Communications Clinical Policy Modifications - Health and Behavior Intervention Visits Provided by Local Health Departments

TABLE 18. OUTPATIENT RESPIRATORY THERAPY SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Outpatient Respiratory Therapy

Respiratory therapists 94010, 94060, 94150, 94375, 94664, 94760, 99503, 99504

• Reported with usual place of service (POS)

• Modifiers GT & CR

SPECIAL BULLETIN COVID-19 #67 Telehealth and Virtual Patient Communications Clinical Policy Modifications - Outpatient Respiratory Therapy

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NC Medicaid Telehealth Billing Code Summary 15 of 22 June 25, 2020

TABLE 19. HYBRID TELEMEDICINE WITH SUPPORTING HOME VISIT SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Hybrid Telemedicine with Supporting Home Visit

• Non-FQHCs (including Local Health Departments)

• Eligible providers to perform the telemedicine visit include:

o Physicians o Nurse practitioners o Physician assistants o Certified nurse midwives

• The assisting care team member performing the home visit should be an appropriately trained delegated staff person.

99347, 99348, 99349, 99350 • Reported with POS 12 (home)

• For Well Child services only:

o Medicaid: EP, GT & CR

o NC Health Choice: TJ, GT & CR

• For Perinatal Services only: See SPECIAL BULLETIN COVID-19 #49 for special billing and coding guidance for perinatal telemedicine visits with a supporting home visit.

• For all other services: Modifiers GT & CR

SPECIAL BULLETIN COVID-19 #78: Telehealth and Virtual Patient Communications Clinical Policy Modifications – Telemedicine with Supporting Home Visit

FQHCs, FQHC Look-Alikes & RHCs • Eligible providers to perform the

telemedicine visit include: o Physicians o Nurse practitioners o Physician assistants o Certified nurse midwives

• The assisting care team member performing the home visit should be an appropriately trained delegated staff person.

• For Well Child hybrid telemedicine with supporting home visits, only: 99347, 99348, 99349, 99350

• For Non-Well Child hybrid telemedicine with supporting home visits: T1015 + Q3014

• Reported with POS 12 (home)

• For Well Child hybrid telemedicine with supporting home visits, only:

o Medicaid: EP, GT & CR

o NC Health Choice: TJ, GT & CR

• For Non-Well Child hybrid telemedicine with supporting home visits: GT & CR

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NC Medicaid Telehealth Billing Code Summary 16 of 22 June 25, 2020

TABLE 20. END-STAGE RENAL DISEASE (ESRD) SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

ESRD Monthly and Daily Capitation Services

• Physicians • Nurse practitioners • Physician assistants

NC Medicaid: 90951, 90952, 90953, 90954, 90955, 90956, 90957, 90958, 90959, 90960, 90961, 90962, 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970 NC Health Choice: 90954, 90955, 90956, 90957, 90958, 90959, 90964, 90965, 90968, 90969

• Reported with usual place of service (POS)

• Modifiers GT & CR

SPECIAL BULLETIN COVID-19 #77: Telehealth and Virtual Patient Communications Clinical Policy Modifications – End Stage Renal Disease Services

Dialysis Training NC Medicaid and NC Health Choice: 90989, 90993

• Reported with usual place of service (POS)

• Modifiers GT & CR

TABLE 21. SKILLED NURSING FACILITIES SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Evaluation and Management Services

• Physicians • Nurse practitioners • Physician assistants

99307, 99308, 99309, 99310

• Reported with usual place of service (POS)

• Modifiers GT & CR

SPECIAL BULLETIN COVID-19 #103: Telehealth and Virtual Patient Communications Clinical Policy Modifications – Nursing Facility Care

Originating Site Facility Fee for Delivery of Telemedicine Services

Skilled Nursing Facilities (for care provided by eligible providers)

Q3014 Note: SNFs may not bill for an originating site facility fee when the SNF Medical Director or a beneficiary’s attending physician is conducting a telemedicine visit

• Skilled nursing facilities are not required to file facility fee claims with Place of Service (POS) Code.

• Modifiers GT & CR

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NC Medicaid Telehealth Billing Code Summary 17 of 22 June 25, 2020

TABLE 22. ENHANCED BEHAVIORAL HEALTH SERVICES SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Mobile Crisis Management (Clinical Coverage Policy 8A)

Please refer to the relevant Clinical Coverage Policy listed in the “Service” column and Special Bulletin COVID-19 #46: Behavioral Health Service Flexibilities for applicable providers and any team member requirements for each specific service

H2011 Modifiers: • GT & CR: For services

delivered via telemedicine (real time, two-way audio/visual)

• CR only: For services delivered via telephone or face-to-face

• Please see Special Bulletin COVID-19 #46: Behavioral Health Service Flexibilities for guidance on which services can be delivered via telemedicine or telephone

Place of Service (POS): • For FFS: Report the with

usual POS • For MCO: Claims

submissions to LME-MCOs will follow the guidance of the LME-MCO

SPECIAL BULLETIN COVID-19 #46: Behavioral Health Service Flexibilities

Diagnostic Assessment (Clinical Coverage Policy 8A)

T1023

Intensive In-Home (Clinical Coverage Policy 8A)

H2022

Multisystemic Therapy (Clinical Coverage Policy 8A)

H2033

Community Support Team (Clinical Coverage Policy 8A)

H2015 HT, HO/HF/HN/U1/HM

Assertive Community Treatment (Clinical Coverage Policy 8A)

H0040

Psychosocial Rehabilitation (Clinical Coverage Policy 8A)

H2017

Child and Adolescent Day Treatment (Clinical Coverage Policy 8A)

H2012 HA

Partial Hospitalization (Clinical Coverage Policy 8A)

H0035

Substance Abuse Intensive Outpatient Program (Clinical Coverage Policy 8A)

H0015, H2035

Substance Abuse Comprehensive Outpatient Treatment (Clinical Coverage Policy 8A)

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NC Medicaid Telehealth Billing Code Summary 18 of 22 June 25, 2020

TABLE 22. ENHANCED BEHAVIORAL HEALTH SERVICES SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Substance Abuse Non-Medical Community Residential Treatment (Clinical Coverage Policy 8A)

Please refer to the relevant Clinical Coverage Policy listed in the “Service” column and Special Bulletin COVID-19 #46: Behavioral Health Service Flexibilities for applicable providers and any team member requirements for each specific service

Modifiers: • GT & CR: For services

delivered via telemedicine (real time, two-way audio/visual)

• CR only: For services delivered via telephone or face-to-face

• Please see Special Bulletin COVID-19 #46: Behavioral Health Service Flexibilities for guidance on which services can be delivered via telemedicine or telephone

Place of Service (POS): • For FFS: Report the with

usual POS • For MCO: Claims

submissions to LME-MCOs will follow the guidance of the LME-MCO

SPECIAL BULLETIN COVID-19 #46: Behavioral Health Service Flexibilities

Substance Abuse Medically Monitored Community Residential Treatment (Clinical Coverage Policy 8A)

H0012, H0013

Non-Hospital Medical Detoxification (Clinical Coverage Policy 8A)

H0010

Peer Support Services (Clinical Coverage Policy 8G)

H0038, H0038HQ

Residential Treatment Services (Clinical Coverage Policy 8D-2)

H0019, H2020

Psychiatric Residential Treatment Facility for Children under Age 21 (Clinical Coverage Policy 8D-1)

RC 0911

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NC Medicaid Telehealth Billing Code Summary 19 of 22 June 25, 2020

TABLE 22. ENHANCED BEHAVIORAL HEALTH SERVICES SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Therapeutic Leave for Psychiatric residential treatment facility (PRTF), Child Residential and Intermediate Care for Individuals with intellectual disabilities (ICF-IDD) (Clinical Coverage Policy 8D-1, 8D-2 and 8E)

Please refer to the relevant Clinical Coverage Policy listed in the “Service” column and Special Bulletin COVID-19 #46: Behavioral Health Service Flexibilities for applicable providers and any team member requirements for each specific service

RC0183 Modifiers: • GT & CR: For services

delivered via telemedicine (real time, two-way audio/visual)

• CR only: For services delivered via telephone or face-to-face

• Please see Special Bulletin COVID-19 #46: Behavioral Health Service Flexibilities for guidance on which services can be delivered via telemedicine or telephone

Place of Service (POS): • For FFS: Report the with

usual POS • For MCO: Claims

submissions to LME-MCOs will follow the guidance of the LME-MCO

SPECIAL BULLETIN COVID-19 #46: Behavioral Health Service Flexibilities

Facility-Based Crisis Services (Clinical Coverage Policy 8A)

S9484, S9484 HA

Medically Supervised or ADATC Detoxification Crisis Stabilization (Clinical Coverage Policy 8A)

H2036

Note: For B3 and NC Innovation waiver and NC TBI waiver telehealth flexibilities, please see Special Bulletin COVID-19 #75 and #76.

TABLE 23. MATERNAL SUPPORT SERVICES PROVIDED BY LOCAL HEALTH DEPARTMENTS SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Home Visit for Postnatal Assessment

Local Health Departments whereby the service is rendered by a registered nurse

99501 • Reported with POS 12 (home)

• Modifiers GT and CR

SPECIAL BULLETIN COVID-19 #84: Telehealth Clinical Policy Modifications – Maternal Support Services Provided by Local Health Departments

Home Visit for Newborn Care and Assessment

99502

Childbirth Education Classes (individual or group classes)

Local Health Departments whereby the service is rendered by a certified childbirth educator

S9442 • Reported with POS 71 (public health clinic)

• Modifiers GT and CR

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NC Medicaid Telehealth Billing Code Summary 20 of 22 June 25, 2020

TABLE 24. FAMILY PLANNING SERVICES FOR MAFDN BENEFICIARIES SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

TELEMEDICINE Office or Other Outpatient Services

• Physicians • Nurse practitioners • Physician assistants • Certified nurse midwives

99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244

• Reported with usual place of service (POS)

• Modifiers GT, CR, FP

SPECIAL BULLETIN COVID-19 #86: Telehealth Clinical Policy Modifications: Family Planning Services for MAFDN Beneficiaries

VIRTUAL PATIENT COMMUNICATIONS Telephonic Evaluation and Management Services

• Physicians • Nurse practitioners • Physician assistants • Certified nurse midwives

99441, 99442, 99443 • Reported with usual place of service (POS)

• Modifiers CR, FP

SPECIAL BULLETIN COVID-19 #86: Telehealth Clinical Policy Modifications: Family Planning Services for MAFDN Beneficiaries

Note: An annual exam date is not required with submission of claims for any family planning service codes listed in Table 24.

TABLE 25. SMOKING AND TOBACCO CESSATION COUNSELING SERVICE APPLICABLE PROVIDERS RATE CODE OR PROCEDURE MODIFIERS & POS SOURCE BULLETIN

Smoking and Tobacco Cessation Counseling

• Physicians • Nurse practitioners • Physician assistants • Certified nurse midwives • FQHCs, FQHC Lookalikes and

RHCs*

99406, 99407 *Billing guidance for FQHCs and RHCs: Smoking and tobacco cessation counseling is a component of a Core Visit provided by Core Service providers and not separately billable as a core service.

• Reported with usual place of service (POS)

• Modifiers GT & CR

SPECIAL BULLETIN COVID-19 #90: Telehealth and Virtual Patient Communications Clinical Policy Modifications - Smoking and Tobacco Cessation Counseling

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NC Medicaid Telehealth Billing Code Summary 21 of 22 June 25, 2020

Appendix: List of Updates to the NC Medicaid Telehealth Billing Code Summary

UPDATE (June 25, 2020) • Updated Telehealth Guidance: Codes that require 2 modifiers (i.e., GT and CR) must be billed with both modifiers or the claim detail will deny.

o Updated Table 2. Telepsychiatry and Telebehavioral Health Services o Updated Table 13. Perinatal Care

• Updated Table 21. Skilled Nursing Facilities includes new evaluation and management codes

UPDATE (May 21, 2020) • Updated Summary Cover - page 1. Notes for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) were removed from the

Summary Cover Page. FQHC-specific directions are provided within the applicable summary code tables. • Updated Table 2. Telepsychiatry and Telebehavioral Health Services. • Updated Table 10. Research-based Behavioral Health (RB-BHT) Treatment for Autism Spectrum Disorder (ASD). • New Table 25. Smoking and Tobacco Cessation Counseling.

UPDATE (May 11, 2020) • Table 19. Added FQHCs, FQHC Look-Alikes & RHCs to the Applicable Providers column. Renamed to Hybrid Telemedicine with Supporting Home

Visit. • New Table 23. Maternal Support Services Provided by Local Health Departments. • New Table 24. Family Planning Services for MAFDN Beneficiaries.

UPDATE (May 4, 2020) • New Table 19. Telemedicine with Supporting Home Visit. • New Table 20. End-Stage Renal Disease (ESRD). • New Table 21. Skilled Nursing Facilities. • New Table 22. Enhanced Behavioral Health Services.

UPDATE (April 28, 2020) • New Table 16. Postpartum Depression Screening. • New Table 17. Health and Behavior Intervention Visits Provided by Local Health Departments. • New Table 18. Outpatient Respiratory Therapy.

UPDATE (April 24, 2020) New Table 15. Well Child Visits.

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NC Medicaid Telehealth Billing Code Summary 22 of 22 June 25, 2020

UPDATE (April 22, 2020) • Table 2. Telepsychiatry and Telebehavioral Health Services, Virtual Patient Communication, Telephone Assessment and Management. FQHCs,

FQHC Look-Alikes, RHCs added to Applicable Providers. FQHCs and RHCs may bill for services provided by specific professionals added to Rate Code or Procedure column.

• Table 10. Research-based Behavioral Health (RB-BHT) Treatment for Autism Spectrum Disorder (ASD). Usual Place of Service and modifier information added to Modifiers & POS column.

• Table 12. Optometry. Place of Service and modifier information added to Modifiers & POS column.

UPDATE (April 17, 2020) • Table 13. Postpartum Care and Pregnancy Medical Home was replaced by Table 13. Perinatal Care. • New Table 14. Remote Physiologic Monitoring.

UPDATE (April 16, 2020) • New sentence added to directions: “Modifier GT must be appended to the CPT or HCPCS code to indicate that a service has been provided via

interactive audio-visual communication. This modifier is not appropriate for services performed telephonically or through email or patient portal. The tables in this document indicate which codes should be billed with the GT modifier in the Modifiers and POS Column.”

• Tables modified as appropriate to accommodate above.

UPDATE (April 9, 2020) • Table 1. Office or Other Outpatient Service and Office and Inpatient Consultation, Modifiers & POS. Guidance clarified to read: For additional

information about providing and billing these services: NC Medicaid clinical coverage policy 1H, telemedicine/telepsychiatry. • Three new tables added:

o Table 11. Self-measured Blood Pressure Monitoring (SMBPM) Services o Table 12. Optometry o Table 13. Postpartum Care and Pregnancy Medical Home